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Covered California pushes for better healthcare as federal spending cuts loom

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Covered California pushes for better healthcare as federal spending cuts loom

Faced with potential federal spending cuts that threaten health coverage and falling childhood vaccination rates, Monica Soni, the chief medical officer of Covered California, has a lot on her plate — and on her mind.

California’s Affordable Care Act health insurance exchange covers nearly 2 million residents and 89% of them receive federal subsidies that reduce their premiums. Many middle-income households got subsidies for the first time after Congress expanded them in 2021, which helped generate a boom in enrollment in ACA exchanges nationwide.

From the original and enhanced subsidies, Covered California enrollees currently get $563 a month on average, lowering the average monthly out-of-pocket premium from $698 to $135, according to data from Covered California.

The 2021 subsidies are set to expire at the end of this year unless Congress renews them. If they lapse, enrollees would be on the hook to pay an average of $101 a month more for health insurance — not counting any premium hikes in 2026 and beyond. And those middle-income earners who did not qualify for subsidies before would lose all financial assistance — $384 a month, on average — which Soni fears could prompt them to drop out.

At the same time, vaccination rates for children 2 and under declined among 7 of the 10 Covered California health plans subject to its new quality-of-care requirements. Soni, a Los Angeles native who came to Covered California in May 2023, oversees that program, in which health plans must meet performance targets on blood pressure control, diabetes management, colorectal cancer screening and childhood vaccinations — or pay a financial penalty.

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Lack of access to such key aspects of care disproportionately affects underserved communities, making Covered California’s effort one of health equity as well. Soni, a Harvard-trained primary care doctor who sees patients one day a week at an urgent care clinic in Los Angeles County’s public safety net health system, is familiar with the challenges those communities face.

Covered California reported last November that its health plans improved on three of the four measures in the first year of the program. But childhood immunizations for those under 2 declined by 4%. The decline is in line with a national trend, which Soni attributed to postpandemic mistrust of vaccines and “more skepticism of the entire medical industry.”

Most parents have heard at least one untrue statement about measles or the vaccine for it, and many don’t know what to believe, according to an April KFF poll.

Health plans improved on the other three measures, but not enough to avoid penalties, which yielded $15 million. The exchange is using that money to fund another effort Soni manages, which helps 6,900 Covered California households buy groceries and contributes to more than 250 savings accounts for children who get routine checkups and vaccines. Some of the penalty money will also be used to support primary care practices around California.

In addition to her bifurcated professional duties, Soni is the mother of two children, ages 4 and 7.

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KFF Health News senior correspondent Bernard J. Wolfson spoke with Soni about the impact of possible federal cuts and the exchange’s initiative to improve care for its enrollees. This interview has been edited for length and clarity.

Q: Covered California has record enrollment of nearly 2 million, boosted by the expanded federal subsidies passed under the Biden administration, which end after this year. What if Congress does not renew them?

A: Our estimates are that it will approach 400,000 Californians who would drop coverage immediately.
We hear every day from our folks that they’re really living on the margins. Until they got some of those subsidies, they could not afford coverage.

As a primary care doctor, I am the one to treat folks who show up with preventable cancers because they were too afraid to think about what their out-of-pocket costs would be. I don’t want to go back to those days.

Q: Congress is considering billions in cuts to Medicaid. How would that affect Covered California and the state’s population more broadly, given that more than 1 in 3 Californians are on Medi-Cal, the state’s version of Medicaid?

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A: Those are our neighbors, our friends. Those are the people working in the restaurants we eat at.

Earlier cancer screenings, better chronic disease control, lower maternal mortality, more substance use disorder treatment: We know that Medicaid saves lives. We know it helps people live longer and better.

As a physician, I would be hard-pressed to argue for rolling back anything that saves lives. It would be very distressing to watch that come to California.

Q: Why did Covered California undertake the Quality Transformation Initiative?

A: We were incredibly successful at covering nearly 2 million, but frankly we didn’t see improvements in quality, and we continue to see gaps for certain populations in terms of outcomes. So, I think the question became much more imperative: Are we getting our money’s worth out of this coverage? Are we making sure people are living longer and better, and if not, how do we up the ante to make sure they are?

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Q: There’s a penalty for not meeting the targets, but no bonuses for meeting them: You meet the goals or else, right?

A: We don’t say it like that, but that is true. And we didn’t make it complicated. It’s only four measures.

It’s things that as a primary care doctor I know are important, that I take care of when I see people in my
practice. We said get to the 66th percentile on these four measures, and there’s no dollars that you have to pay. If you don’t, then we collect those funds.

Q: And you use the penalty money to fund the grocery assistance and child savings accounts.

A: That’s exactly right. We had this opportunity to think about what would we use these dollars for and how we actually make a difference in people’s lives. So, we cold-called hundreds of people, we sent surveys out to thousands of folks, and what we heard overwhelmingly was how expensive it is to live in California; that folks are making trade-offs between food and transportation, between child care and food — just impossible decisions.

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Q: You will put up to $1,000 a child into those savings accounts, right?

A: That’s right. It’s tied to doing those healthy behaviors, going to child well visits and getting recommended vaccines. We looked at the literature, and once you get to even just $500 in an account, the likelihood of a kid going to a two- or four-year school increases significantly. It’s actually because they’re hopeful about their future, and it changes their path of upward mobility, which we know changes their health outcome.

Q: Given the rise in vaccine skepticism, are you worried that the recent measles outbreak could grow?

A: I am very concerned about it. I was actually reading some posts from a physician colleague who trained decades earlier and was talking about all the diseases that my generation of physicians have never seen. We don’t actually know how to diagnose and take care of a number of infectious diseases because they mostly have been eradicated or outbreaks have been really contained. So, I feel worried. I’ve been brushing off my old textbooks.

Wolfson writes for KFF Health News, a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF — an independent source for health policy research, polling and journalism.

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Trump orders federal agencies to stop using Anthropic’s AI after clash with Pentagon

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Trump orders federal agencies to stop using Anthropic’s AI after clash with Pentagon

President Trump on Friday directed federal agencies to stop using technology from San Francisco artificial intelligence company Anthropic, escalating a high-profile clash between the AI startup and the Pentagon over safety.

In a Friday post on the social media site Truth Social, Trump described the company as “radical left” and “woke.”

“We don’t need it, we don’t want it, and will not do business with them again!” Trump said.

The president’s harsh words mark a major escalation in the ongoing battle between some in the Trump administration and several technology companies over the use of artificial intelligence in defense tech.

Anthropic has been sparring with the Pentagon, which had threatened to end its $200-million contract with the company on Friday if it didn’t loosen restrictions on its AI model so it could be used for more military purposes. Anthropic had been asking for more guarantees that its tech wouldn’t be used for surveillance of Americans or autonomous weapons.

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The tussle could hobble Anthropic’s business with the government. The Trump administration said the company was added to a sweeping national security blacklist, ordering federal agencies to immediately discontinue use of its products and barring any government contractors from maintaining ties with it.

Defense Secretary Pete Hegseth, who met with Anthropic’s Chief Executive Dario Amodei this week, criticized the tech company after Trump’s Truth Social post.

“Anthropic delivered a master class in arrogance and betrayal as well as a textbook case of how not to do business with the United States Government or the Pentagon,” he wrote Friday on social media site X.

Anthropic didn’t immediately respond to a request for comment.

Anthropic announced a two-year agreement with the Department of Defense in July to “prototype frontier AI capabilities that advance U.S. national security.”

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The company has an AI chatbot called Claude, but it also built a custom AI system for U.S. national security customers.

On Thursday, Amodei signaled the company wouldn’t cave to the Department of Defense’s demands to loosen safety restrictions on its AI models.

The government has emphasized in negotiations that it wants to use Anthropic’s technology only for legal purposes, and the safeguards Anthropic wants are already covered by the law.

Still, Amodei was worried about Washington’s commitment.

“We have never raised objections to particular military operations nor attempted to limit use of our technology in an ad hoc manner,” he said in a blog post. “However, in a narrow set of cases, we believe AI can undermine, rather than defend, democratic values.”

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Tech workers have backed Anthropic’s stance.

Unions and worker groups representing 700,000 employees at Amazon, Google and Microsoft said this week in a joint statement that they’re urging their employers to reject these demands as well if they have additional contracts with the Pentagon.

“Our employers are already complicit in providing their technologies to power mass atrocities and war crimes; capitulating to the Pentagon’s intimidation will only further implicate our labor in violence and repression,” the statement said.

Anthropic’s standoff with the U.S. government could benefit its competitors, such as Elon Musk’s xAI or OpenAI.

Sam Altman, chief executive of OpenAI, the company behind ChatGPT and one of Anthropic’s biggest competitors, told CNBC in an interview that he trusts Anthropic.

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“I think they really do care about safety, and I’ve been happy that they’ve been supporting our war fighters,” he said. “I’m not sure where this is going to go.”

Anthropic has distinguished itself from its rivals by touting its concern about AI safety.

The company, valued at roughly $380 billion, is legally required to balance making money with advancing the company’s public benefit of “responsible development and maintenance of advanced AI for the long-term benefit of humanity.”

Developers, businesses, government agencies and other organizations use Anthropic’s tools. Its chatbot can generate code, write text and perform other tasks. Anthropic also offers an AI assistant for consumers and makes money from paid subscriptions as well as contracts. Unlike OpenAI, which is testing ads in ChatGPT, Anthropic has pledged not to show ads in its chatbot Claude.

The company has roughly 2,000 employees and has revenue equivalent to about $14 billion a year.

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Video: The Web of Companies Owned by Elon Musk

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Video: The Web of Companies Owned by Elon Musk

new video loaded: The Web of Companies Owned by Elon Musk

In mapping out Elon Musk’s wealth, our investigation found that Mr. Musk is behind more than 90 companies in Texas. Kirsten Grind, a New York Times Investigations reporter, explains what her team found.

By Kirsten Grind, Melanie Bencosme, James Surdam and Sean Havey

February 27, 2026

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Commentary: How Trump helped foreign markets outperform U.S. stocks during his first year in office

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Commentary: How Trump helped foreign markets outperform U.S. stocks during his first year in office

Trump has crowed about the gains in the U.S. stock market during his term, but in 2025 investors saw more opportunity in the rest of the world.

If you’re a stock market investor you might be feeling pretty good about how your portfolio of U.S. equities fared in the first year of President Trump’s term.

All the major market indices seemed to be firing on all cylinders, with the Standard & Poor’s 500 index gaining 17.9% through the full year.

But if you’re the type of investor who looks for things to regret, pay no attention to the rest of the world’s stock markets. That’s because overseas markets did better than the U.S. market in 2025 — a lot better. The MSCI World ex-USA index — that is, all the stock markets except the U.S. — gained more than 32% last year, nearly double the percentage gains of U.S. markets.

That’s a major departure from recent trends. Since 2013, the MSCI US index had bested the non-U.S. index every year except 2017 and 2022, sometimes by a wide margin — in 2024, for instance, the U.S. index gained 24.6%, while non-U.S. markets gained only 4.7%.

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The Trump trade is dead. Long live the anti-Trump trade.

— Katie Martin, Financial Times

Broken down into individual country markets (also by MSCI indices), in 2025 the U.S. ranked 21st out of 23 developed markets, with only New Zealand and Denmark doing worse. Leading the pack were Austria and Spain, with 86% gains, but superior records were turned in by Finland, Ireland and Hong Kong, with gains of 50% or more; and the Netherlands, Norway, Britain and Japan, with gains of 40% or more.

Investment analysts cite several factors to explain this trend. Judging by traditional metrics such as price/earnings multiples, the U.S. markets have been much more expensive than those in the rest of the world. Indeed, they’re historically expensive. The Standard & Poor’s 500 index traded in 2025 at about 23 times expected corporate earnings; the historical average is 18 times earnings.

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Investment managers also have become nervous about the concentration of market gains within the U.S. technology sector, especially in companies associated with artificial intelligence R&D. Fears that AI is an investment bubble that could take down the S&P’s highest fliers have investors looking elsewhere for returns.

But one factor recurs in almost all the market analyses tracking relative performance by U.S. and non-U.S. markets: Donald Trump.

Investors started 2025 with optimism about Trump’s influence on trading opportunities, given his apparent commitment to deregulation and his braggadocio about America’s dominant position in the world and his determination to preserve, even increase it.

That hasn’t been the case for months.

”The Trump trade is dead. Long live the anti-Trump trade,” Katie Martin of the Financial Times wrote this week. “Wherever you look in financial markets, you see signs that global investors are going out of their way to avoid Donald Trump’s America.”

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Two Trump policy initiatives are commonly cited by wary investment experts. One, of course, is Trump’s on-and-off tariffs, which have left investors with little ability to assess international trade flows. The Supreme Court’s invalidation of most Trump tariffs and the bellicosity of his response, which included the immediate imposition of new 10% tariffs across the board and the threat to increase them to 15%, have done nothing to settle investors’ nerves.

Then there’s Trump’s driving down the value of the dollar through his agitation for lower interest rates, among other policies. For overseas investors, a weaker dollar makes U.S. assets more expensive relative to the outside world.

It would be one thing if trade flows and the dollar’s value reflected economic conditions that investors could themselves parse in creating a picture of investment opportunities. That’s not the case just now. “The current uncertainty is entirely man-made (largely by one orange-hued man in particular) but could well continue at least until the US mid-term elections in November,” Sam Burns of Mill Street Research wrote on Dec. 29.

Trump hasn’t been shy about trumpeting U.S. stock market gains as emblems of his policy wisdom. “The stock market has set 53 all-time record highs since the election,” he said in his State of the Union address Tuesday. “Think of that, one year, boosting pensions, 401(k)s and retirement accounts for the millions and the millions of Americans.”

Trump asserted: “Since I took office, the typical 401(k) balance is up by at least $30,000. That’s a lot of money. … Because the stock market has done so well, setting all those records, your 401(k)s are way up.”

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Trump’s figure doesn’t conform to findings by retirement professionals such as the 401(k) overseers at Bank of America. They reported that the average account balance grew by only about $13,000 in 2025. I asked the White House for the source of Trump’s claim, but haven’t heard back.

Interpreting stock market returns as snapshots of the economy is a mug’s game. Despite that, at her recent appearance before a House committee, Atty. Gen. Pam Bondi tried to deflect questions about her handling of the Jeffrey Epstein records by crowing about it.

“The Dow is over 50,000 right now, she declared. “Americans’ 401(k)s and retirement savings are booming. That’s what we should be talking about.”

I predicted that the administration would use the Dow industrial average’s break above 50,000 to assert that “the overall economy is firing on all cylinders, thanks to his policies.” The Dow reached that mark on Feb. 6. But Feb. 11, the day of Bondi’s testimony, was the last day the index closed above 50,000. On Thursday, it closed at 49,499.50, or about 1.4% below its Feb. 10 peak close of 50,188.14.

To use a metric suggested by economist Justin Wolfers of the University of Michigan, if you invested $48,488 in the Dow on the day Trump took office last year, when the Dow closed at 48,448 points, you would have had $50,000 on Feb. 6. That’s a gain of about 3.2%. But if you had invested the same amount in the global stock market not including the U.S. (based on the MSCI World ex-USA index), on that same day you would have had nearly $60,000. That’s a gain of nearly 24%.

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Broader market indices tell essentially the same story. From Jan. 17, 2025, the last day before Trump’s inauguration, through Thursday’s close, the MSCI US stock index gained a cumulative 16.3%. But the world index minus the U.S. gained nearly 42%.

The gulf between U.S. and non-U.S. performance has continued into the current year. The S&P 500 has gained about 0.74% this year through Wednesday, while the MSCI World ex-USA index has gained about 8.9%. That’s “the best start for a calendar year for global stocks relative to the S&P 500 going back to at least 1996,” Morningstar reports.

It wouldn’t be unusual for the discrepancy between the U.S. and global markets to shrink or even reverse itself over the course of this year.

That’s what happened in 2017, when overseas markets as tracked by MSCI beat the U.S. by more than three percentage points, and 2022, when global markets lost money but U.S. markets underperformed the rest of the world by more than five percentage points.

Economic conditions change, and often the stock markets march to their own drummers. The one thing less likely to change is that Trump is set to remain president until Jan. 20, 2029. Make your investment bets accordingly.

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